Shrinking

*Minor spoilers ahead!*

Have you seen the Apple TV+ series “Shrinking” yet? The hit series, co-created by and starring Jason Segel, is about a psychotherapy group practice that operates out of the city of Pasadena. The practice is owned and operated by Paul Rhoades (Harrison Ford), and employs Jimmy Laird (Segel) and Gaby Evans (Jessica Williams) as staff therapists. The series follows Jimmy as he grieves the untimely death of his wife, attempts to raise his teenage daughter in the wake of this tragedy, and does his best to maintain his relationships with his patients while processing his own grief. 

First, some praise about the way the show depicts therapists. All three of the therapists, Paul, Jimmy, and Gaby, practice in a way that is authentic to the people they are. Paul is gruff, straight to the point, and boundaried. Jimmy is affable and gentle even in his interventions with his patients. Gabby is colloquial, funny, and disarming in the therapy room. All of these attributes are shown to be consistent with who they are in their every day lives. 

Authenticity is incredibly important for a therapist. Our patients need to feel that they are interacting with the “real” us - not some distant, robotic therapist version of a human being. They value our real reactions to what they share - tears, laughter, concern, surprise, excitement, etc. They want to be able to see the person behind the profession. Not only does it help to build trust in the room, but it also leads to better therapeutic outcomes. So many young therapists (myself included) tend to begin their career trying to be more like their supervisors or some image of a therapist they’ve had in their minds for years. They channel the therapist who strokes their chin or bites on their glasses while inquisitively saying “and how does that make you feel?” A growing edge for many therapists is to become more ourselves and less of what’s “expected” of a therapist. Shrinking presents this well. 

Now for what’s not so good. Obviously the series begins with Jimmy breaking clinical, ethical, and legal boundaries by inserting himself in to the lives of his patients. In one case, he even allows a patient to insert himself into Jimmy’s own life, and this patient moves into Jimmy’s back house. He is warned by Paul, his mentor, to be careful with breaking boundaries as it can only serve to harm the patient. True to this perspective, the first season shows the viewer this very danger. Jimmy meddles in one patient’s life to disastrous consequences. 

I must admit, I appreciated this portrayal at first. There’s a reason therapists are bound by ethical and legal codes when it comes to patient contact. Those codes exist to protect patients from the very thing Shrinking eventually portrays, and I’m glad they did not shy away from showing the potential consequences. 

However, in later seasons, the writers of Shrinking have gone in a different direction from showing the potential consequences of boundary breaking dual relationships. The show depicts another therapist breaking these important boundaries and developing relationships with patients outside of the therapy room, once again to devastating consequences. Only this time, the writers hand-wave the consequences as inevitable and not the fault of the boundary breaking therapist who, as Paul indicates, “did nothing wrong.” 

I’m not sure why the writers took this approach with a topic they were more willing to show as being problematic in earlier seasons. The particular consequence that happens later in season 3 is directly related to the boundary violation engaged by one of the therapists, and this therapist very much “did something wrong.” Why would the writers pull their punch here? What are they trying to say?

So why are therapists bound to a code of ethics to maintain strong boundaries between therapist and patient? Some people may think the boundaries serve to protect the personal lives of the therapist. I often have patients ask me if they are “allowed” to inquire about my personal life, as though some ethical code forbids me from sharing anything revealing about who I am outside of my profession. That’s not true! As a patient, you can ask your therapist anything you want! It’s the therapist’s job to decide whether or not to answer, and the reason for that decision is centered around what would be best for the patient. These “answers” are called “disclosures” in the therapy world - e.g. the therapist “discloses” personal information. Because conversations in the therapy room are chock full of meaning, it’s the therapist’s duty to interpret what meaning a patient might make related to the answer to a personal question. If a therapists decided disclose anything personal, it must also be followed up with process and interpretation.

Another important reason for boundaries around the therapeutic relationship is that when relational boundaries are crossed, it can contaminate the very important work of therapy. As therapists, we don’t give advice. It’s our job to help a person come to terms with their particular situation and make informed decisions on their own. We do this by engaging our patients as a listening partner who can help identify unconscious drives and unseen motivators. The boundaries also serve to avoid what are called “dual relationships.” A therapist cannot also be a friend. A therapist can’t hang out with a patient outside of the therapy room. This would too easily disrupt the sanctity and privacy of a relationship intended to produce trust and safety. 

You may be thinking, “you’re overthinking this! It’s all about entertainment!” Maybe that’s the goal - to immerse the viewer into the lives of all the characters in the show and not just the professional lives of the therapists. The fact that Paul, Jimmy, and Gaby are therapists becomes secondary to their other relationships. I can understand that shift. But in a world where medical dramas like The Pitt are praised for their accuracy, why can't we have a show about therapists that strives to be accurate about the profession? Why can’t we be treated to a show with good depictions of therapy and therapists who have strong boundaries between patients and their personal lives? 

I love Shrinking. I enjoy watching it every week. It’s appointment television for me! I especially love the fact that the show is set in the city where I operate my own private practice. I only wish therapists were depicted in media as more proficient than they typically are. In a future post, I’ll share some of my favorite film and TV depictions of therapists that really get it right (hint: Lars and the Real Girl). 

Oh, and the most unrealistic part of Shrinking? That a therapist can afford a $2M Pasadena Craftsman…